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World Sepsis Day: the future of sepsis testing is bio-markers

Sepsis is a big killer. Out of the 100,000 cases of sepsis suffered in Britain each year around 37,000 of them will end in death. That is more than the number of bowel and breast cancer deaths combined. Up to 46% of the NHS’ most expensive bed days – in the ICU – are taken up by patients suffering from severe sepsis and it is thought that the annual cost to the NHS is £2.3bn. Yet these figures only make up a small part of the picture. Globally, 1.8m deaths are recorded each year, with the true figure being estimated to be much higher.

Often people think of sepsis as a severe infection. In fact it is the body’s overreaction to an infection – it starts to injure its own tissues and organs. The body’s usual response to a minor infection, such as a common cold or one caused by an insect bite, is to seal off the area and fight the infection. When this response is too severe, inflammation affects the whole body and can lead to shock, multiple organ failure and death.

Leading factors which contribute to so many avoidable deaths are delayed diagnosis and the lack of a single test which detects the presence of sepsis. This is why the Global Sepsis Alliance is launching its first ever World Sepsis Day on Thursday 13th September – it aims to raise awareness of sepsis among clinicians and the public in order to cut the number of global cases by twenty per cent as well as improve rehabilitation.

With a swift diagnosis and a dose of the correct antibiotics sepsis can be treated successfully. The main challenge is making sure that sepsis is spotted early despite its flu like symptoms. There are various stages of sepsis, with the risk of death increasing with each. There is a low risk of death from a simple infection, but this increases to ten per cent if the body becomes inflamed. The risk of death jumps again to thirty four per cent when the body reaches severe sepsis. Finally, if the body gets to a stage of septic shock, there is a fifty per cent chance of death.

Advice on recognising sepsis is available on the UK Sepsis Trust Website. It says, ‘If a person has more than one of a very high (or very low) temperature, a racing heart beat, rapid breathing, or is confused/slurring their speech then they may have sepsis and should seek medical attention. If any of these features exist and the skin is cool, pale or mottled, the patient has lost consciousness or has not passed water for more than 18 hours then the patient needs to be taken to hospital as soon as possible.’

‘For every hour we delay in getting the source controlled and the right antibiotics into the patient, their risk of death goes up by nearly eight per cent. This is an emergency – we need to get the treatment into the patient within the first hour following presentation. Because there is no single blood test we can do to say sepsis is present or not, what this hugely relies on is an index of suspicion. We need doctors, nurses, GPs, paramedics to be aware of sepsis and to think about it.’

As you have read, speed is of the essence when dealing with sepsis. This applies to developing new tests as well as diagnosing each case before it reaches the ICU. Being able to easily detect the presence of sepsis from a blood or breath sample would streamline the route to treatment and improve survival rates. BIVDA spoke to Dr Daniels recently and he emphasised that the future of sepsis testing would ideally see bio-marker panels in wide-spread use. At present clinicians rely on the lactate test (which measures the level of oxygen in the blood, operating as a risk stratifier rather than a diagnostic) and procalcitonin test (which detects severe sepsis by measuring levels of the peptide procalcitonin which is elevated in those experiencing inflammation). Dr Daniels wants to see a bio-marker for sepsis itself which is effective even in the early stages.

Last April twelve research and development projects were awarded £8m to improve the future diagnosis, detection and management of sepsis. The grant funding – from the Technology Strategy Board, the Department of Health, Ministry of Defence, Home Office, Engineering and Physical Sciences Research Council and Medical Research Council – will be matched by funding from the UK companies involved in the projects, bringing the total value of the R&D to over £15 million.

‘There is universal recognition of the need for new and improved diagnostic tools to help in the management of sepsis. The products that will emerge from this important research and development will help to reduce the economic burden, death and illness from sepsis and infectious diseases and create opportunities for UK companies in the huge global market for diagnostic devices.’

When it comes to the future of sepsis diagnostics, we need to get to the future fast.

Don't forget to follow our tweets about #WorldSepsisDay for #TestingTuesday on 11th September.